Theses and Dissertations at Montana State University (MSU)
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Item Atypical antipsychotics and metabolic side effect monitoring: a quality improvement project(Montana State University - Bozeman, College of Nursing, 2022) Maricich, Allison Nicole; Chairperson, Graduate Committee: Lindsay BenesSecond-generation antipsychotics (SGAs) have increasingly been utilized by psychiatric providers for patients experiencing a wide array of psychiatric disorders. Originally, SGAs were approved for patients 18 years of age and older; they now have been more consistently utilized in patients under the age of 18. SGAs have significant benefits for many patients, although metabolic side effects from the medication can be detrimental to patients' overall sense of wellbeing. The doctor of nursing practice (DNP) quality improvement (QI) project aimed to improve the metabolic screening rates of adolescent patients admitted to an inpatient residential unit at a pediatric psychiatric hospital. This was done by implementing a paper screening tool that outlined which screening laboratory values had been completed, which needed completing, and when each of these laboratory values were ordered for completion, highlighting a fasting lipid panel, hemoglobin A1c, weight, and blood pressure. A four-week implementation period took place from February 4, 2022 to March 4, 2022. Participants in the project included four psychiatric providers: two psychiatric mental health nurse practitioners (PMHNP) and two psychiatrists. Procedures that took place included (1) providers were educated on the purpose of the QI project and the importance of metabolic screening, (2) the paper screening tool was completed for patients prescribed SGAs, (3) laboratory studies were ordered based on the provider's discretion after completing the paper document, and (4) the paper document was stored and scanned into the patient's chart upon discharge. The results indicated that 75% of patients prescribed SGAs had paper screening tools completed, 85% of patients prescribed SGAs had metabolic screening laboratory studies ordered, and 55% of patients prescribed SGAs had metabolic screening laboratory studies completed. These findings mirrored current literature regarding metabolic screening in patients taking SGAs, suggesting that with the implementation of consistent education, completion of a physical paper screening tool, and systematic ordering of metabolic screening laboratory values, metabolic screening rates improve. The QI project showed success in the preliminary stages and throughout the four-week implementation timeframe, indicating that continuing the project will likely have benefits for adolescent patients prescribed SGAs in residential psychiatric units.Item Improving treatment of metabolic side effects from atypical antipsychotics(Montana State University - Bozeman, College of Nursing, 2021) Galahan, Alicia Marie; Chairperson, Graduate Committee: Margaret HammerslaAtypical antipsychotics are commonly used to treat a variety of mental health disorders in children and adolescents. Prescribing atypical antipsychotics is not without risk as the development of metabolic side effects can lead to reduced life expectancy from chronic metabolic diseases. The metabolic side effects from atypical antipsychotics are considered treatable medical conditions requiring appropriate screening and intervention. Despite recommendations, psychiatric providers do not consistently screen and treat metabolic abnormalities, creating a gap in care for these individuals. This quality improvement project took place on an adolescent inpatient residential unit. This project focused on incorporating recommendations from clinical practice guidelines by focusing on improving rates of metabolic screening and utilization of treatment interventions when metabolic abnormalities are identified to reduce the burden of metabolic side effects for patients. The Plan-Do-Study-Act framework was used to guide this quality improvement project over six weeks with four separate cycles varying in duration from one to two weeks each. A metabolic screening bundle for psychiatric provider notes was created within the electronic health record to improve ease of interpreting metabolic screening values and identifying need for further intervention. At the end of the quality improvement project, rates of metabolic screening remained unchanged. The rate of patients receiving treatment interventions increased and multiple patients received more than one treatment intervention. Treatment modalities studied included metformin, individual physical activity, and nutritionist consult. This quality improvement project sought to decrease patients experiencing metabolic abnormalities after treatment with atypical antipsychotic medication, but effectiveness was unable to be measured due to the short time frame. Metabolic screening is a necessary part of atypical antipsychotic treatment that needs to be completed upon initiation of medication and at future appointments. Once metabolic screening is completed, further education on potential treatment interventions for metabolic abnormalities needs to be discussed with the patient and other professionals involved in their care to improve patient outcomes.